Inflammation is implicated in the pathogenesis of erythropoietin (EPO) resistance in patients with end-stage renal disease. Interleukin (IL)-6 and tumor necrosis factor (TNF)-alpha are suggested to suppress erythropoiesis in uremia. Insulin like growth factor (IGF)-1 has been proposed to stimulate erythropoiesis. Nocturnal hemodialysis (NHD) has been demonstrated to improve anemia management with enhanced EPO responsiveness without altering survival of red blood cells. We tested the hypothesis that augmentation of uremia clearance by NHD results in a reduction of proinflammatory cytokine levels, thereby enhancing EPO responsiveness. Using a cross-sectional study design, 14 prevalent patients on NHD and 14 patients on conventional hemodialysis (CHD) matched for age and comorbidities and controlled for hemoglobin concentrations and iron status were studied. Outcome variables included EPO requirement and plasma levels of EPO, parathyroid hormone, C reactive protein, IL-6, TNF-alpha, and IGF-1. The primary outcome was to determine the between group differences in (1) cytokine profile and (2) EPO requirement. The secondary outcome was to examine the potential correlation between cytokine levels and EPO requirement. There were no significant differences in patient characteristics, comorbidities, hemoglobin, iron indices, and parathyroid hormone levels between the two cohorts. EPO requirement was significantly lower in the NHD cohort [90.5 +/- 22.1 U/kg/ week (NHD) vs. 167.2 +/- 25.4 U/kg/week (CHD), p = 0.04]. Plasma IL-6 levels were lower in the NHD cohort [3.9 +/- 0.7 pg/ml (NHD) vs. 6.5 +/- 0.8 pg/ml (CHD), p = 0.04]. C reactive protein tended to decrease [4.59 +/- 1.34 (NHD) vs. 8.43 +/- 1.83 mg/L (CHD), p = 0.14]. TNF-alpha, and IGF-1 levels did not differ between the two groups. Direct associations were found between EPO requirement and C reactive protein levels (R = 0.62, p = 0.001), and IL-6 levels (R = 0.57, p = 0.002). Augmentation of uremic clearance by NHD improves EPO responsiveness in end-stage renal disease. A possible mechanism for this improvement is through better control of inflammation, as manifested by lowering of plasma IL-6 levels. Further studies are required to clarify the mechanisms by which NHD decreases inflammation.
Background: Differences in immuno-tein (anti-NP) at 6-7 and 12 weeks afer than in those who received mRNA-1273. genicity between mRNA SARS-CoV-2 the second dose of vaccine and com-For anti-spike, 70 of 122 patients (57.4%) vaccines have not been well character-pared those levels with the median con-who received BNT162b2 maintained the ized in patients undergoing dialysis. We valescent serum antibody levels from convalescent level versus 68 of 71 (96%) of compared the serologic response in 211 controls who were previously those who received mRNA-1273 (p < patients undergoing maintenance infected with SARS-CoV-2. 0.001). For anti-RBD, 47 of 122 patients hemodialysis afer vaccination against (38.5%) who received BNT162b2 main-SARS-CoV-2 with BNT162b2 (Pfizer-Results: At 6-7 weeks afer 2-dose vaccin-tained the anti-RBD convalescent level BioNTech) and mRNA-1273 (Moderna). ation, we found that 51 of 70 patients versus 45 of 71 (63%) of those who (73%) who received BNT162b2 and 83 of received mRNA-1273 (p = 0.002). Methods: We conducted a prospective 87 (95%) who received mRNA-1273 observational cohort study at 2 academic attained convalescent levels of anti-spike Interpretation: In patients undergoing centres in Toronto, Canada, from Feb. 2, antibody (p < 0.001). In those who hemodialysis, mRNA-1273 elicited a stron-2021, to July 20, 2021, which included received BNT162b2, 35 of 70 (50%) ger humoral response than BNT162b2. 129 and 95 patients who received the reached the convalescent level for anti-Given the rapid decline in immunogen-BNT162b2 and mRNA-1273 SARS-CoV-2RBD compared with 69 of 87 (79%) who icity at 12 weeks in patients who received vaccines, respectively. We measured SARS-received mRNA-1273 (p < 0.001). At BNT162b2, a third dose is recommended CoV-2 immunoglobulin G antibodies to the 12 weeks afer the second dose, anti-spike in patients undergoing dialysis as a prispike protein (anti-spike), receptor binding and anti-RBD levels were significantly mary series, similar to recommendations domain (anti-RBD) and nucleocapsid pro-lower in patients who received BNT162b2 for other vulnerable populations. Patients with end-stage kidney disease who are receiving with the general population, and a review of 35 studies involving maintenance hemodialysis (HD) are at increased risk for dialysis patients found that in the 1-month period afer 2-dose vacsevere COVID-19, with mortality rates ranging from 9% to cination, seroconversion rates ranged from 70% to 96%. 5 28%. 1,2 Highly effective vaccines have been developed against The BNT162b2 (Pfizer BioNTech) and mRNA-1273 (Moderna) SARS-CoV-2, with 94.1%-95% eficacy in reducing the risk of severe SARS-CoV-2 vaccines are both lipid nanoparticle-encapsulated, COVID-19 (D614G strain) as confirmed by 2 large randomized con-nucleoside-modified mRNA encoding for the full-length SARStrolled trials; however, these studies included limited numbers of CoV-2 spike protein stabilized in its prefusion conformation. The patients with kidney disease. 3,4 Humoral response to vaccination ...
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